MEDICARE: MRS. JAMIE MICHELLE DURKOVIC MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)	2005080	VA

General Provider Information

NPI Number	:	1841203627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE MICHELLE DURKOVIC MS

Provider Business Mailing Address
First Line	:	8501 CHASE GLEN CIR
Second Line	:
City	:	FAIRFAX STATION
State	:	VA
Zip	:	22039-3307
Country	:	US
Telephone Number	:	703-690-5260
Fax Number	:	703-690-5260

Provider Business Practice Location Address
First Line	:	8501 CHASE GLEN CIR
Second Line	:
City	:	FAIRFAX STATION
State	:	VA
Zip	:	22039-3307
Country	:	US
Telephone Number	:	703-690-5260
Fax Number	:	703-690-5260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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